Browsing by Author "Whalen, Christopher"

Now showing 1 - 9 of 9
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    Acceptance of Routine Testing for HIV among Adult Patients at the Medical Emergency Unit at a National Referral Hospital in Kampala, Uganda
    (AIDS and Behavior, 2007) Nakanjako, Damalie; Kamya, Moses; Mayanja-Kizza, Harriet; Freers, Jurgen; Whalen, Christopher; Katabira, Elly
    HIV testing is an entry point to comprehensive HIV/AIDS prevention and care. In Uganda, Routine Testing and Counseling for HIV (RTC) is not widely offered as part of standard medical care in acute care settings. This study determined the acceptance of RTC in a medical emergency setting at Mulago national referral hospital. We interviewed 233 adult patients who were offered HIV testing. Overall, 83% were unaware of their HIV serostatus and 88% of these had been to a health unit in the previous six months. Of the 208 eligible for HIV testing, 95% accepted to test. Half the patients were HIV infected and 77% of these were diagnosed during the study. HIV testing was highly acceptable and detected a significant number of undiagnosed HIV infections. We recommend adoption of RTC as standard of care in the medical emergency unit in order to scale HIV diagnosis and linkage to HIV/AIDS care.
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    Body composition among HIV-Seropositive and HIV-Seronegative adult patients with Pulmonary Tuberculosis in Uganda
    (Elsevier Inc, 2009) Mupere, Ezekiel; Zalwango, Sarah; Chiunda, Allan; Okwera, Alphonse; Mugerwa, Roy; Whalen, Christopher
    Body wasting is a prominent and cardinal feature of tuberculosis (TB) (1, 2) and is a marker of disease severity and outcome. In sub-Saharan Africa, a large proportion of patients with TB also have coinfection with human immunodeficiency virus (HIV) (3). Coinfection may worsen the wasting seen in either TB or HIV infection alone (4, 5). Wasting in TB is associated with reduced caloric intake due to anorexia or loss of appetite and increase in consumption of calories due to altered metabolism induced by inflammation and immune response (6–8). Several studies (9–15) in sub-Saharan Africa have shown the impact of dual infection with HIV and TB on nutritional
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    Capacity Building For The Clinical Investigation Of AIDS Malignancy In East Africa
    (Cancer Detection and Prevention, 2005) Orem, Jackson; Otieno, Mwanda W.; Banura, Cecily; Mbidde, Edward Katongole; Johnson, John L.; Ayers, Leona; Ghannoum, Mahmoud; Fu, Pingfu; Feigal, Ellen G.; Black, Jodi; Whalen, Christopher; Lederman, Michael; Remick, Scot C.
    To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic.An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies.A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned.In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.
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    Human Nutrition and Metabolism Severity of Human Immunodeficiency Virus Infection Is Associated with Decreased Phase Angle, Fat Mass and Body Cell Mass in Adults with Pulmonary Tuberculosis Infection in Uganda
    (Journal of Nutrition, 2001) Shah, Snehal; Whalen, Christopher; Kotler, Donald P.; Mayanja, Harriet; Namale, Alice; Melikian, George; Mugerwa, Roy; Semba, Richard D.
    Although coinfection with tuberculosis and human immunodeficiency virus (HIV) is emerging as a major problem in many developing countries, nutritional status has not been well characterized in adults with tuberculosis and HIV infection. We compared nutritional status between 261 HIV-positive and 278 HIV-negative adults with pulmonary tuberculosis in Kampala, Uganda, using anthropometry and bioelectrical impedance analysis. Among 163 HIV-positive and 199 HIV-negative men, intracellular water–to–extracellular water (ICW:ECW) ratio was 1.48 6 0.26 and 1.59 6 0.48 (P 5 0.006) and phase angle was 5.42 6 1.05 and 5.76 6 1.30 (P 5 0.009), respectively. Among 98 HIV-positive and 79 HIV-negative women, ICW:ECW was 1.19 6 0.16 and 1.23 6 0.15 (P 5 0.11) and phase angle was 5.35 6 1.27 and 5.43 6 0.93 (P 5 0.61), respectively. There were no significant differences in BMI, body cell mass, fat mass or fat-free mass between HIV-positive and HIV-negative adults. Among HIV-positive subjects, BMI, ICW:ECW, body cell mass, fat mass and phase angle were significantly lower among those with CD41 lymphocytes # 200 cells/ m L compared with those who had .200 cells/ m L. In sub- Saharan Africa, coinfection with pulmonary tuberculosis and HIV is associated with smaller body cell mass and intracellular water, but not fat-free mass, and by large differences in ICW:ECW and phase angle
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    Indices to Measure Risk of HIV Acquisition in Rakai, Uganda
    (PLoS ONE, 2014) Kagaayi, Joseph; Gray, Ronald H.; Whalen, Christopher; Fu, Pingfu; Neuhauser, Duncan; McGrath, Janet W.; Sewankambo, Nelson K.; Serwadda, David; Kigozi, Godfrey; Nalugoda, Fred; Reynolds, Steven J.; Wawer, Maria J.; Singer, Mendel E.
    Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed gender specific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda. Methods: We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike’s information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell’s concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models.
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    Level of understanding of co-trimoxazole use among HIV infected, recurrent pulmonary tuberculosis suspects at a national referral tuberculosis clinic in Kampala, Uganda: a qualitative analysis.
    (African Health Sciences, 2015) Okwera, Alphonse; Mafigiri, David K.; Guwatudde, David; Whalen, Christopher; Joloba, Moses
    Co-trimoxazole use is the standard of care for preventing Pneumocystis jirovecii pneumonia in sub-Saharan Africa but implementation remains slow. Co-trimoxazole is self- administered with uncertain adherence. Knowledge of co-trimoxazole use among HIV infected persons is unknown. Objectives: To assess knowledge, attitudes and practices of co-trimoxazole use among HIV infected adults evaluated for recurrent PTB in Kampala, Uganda. Methods: A qualitative study utilizing 5 focus group discussions among 30 HIV infected PTB suspects at the national referral tuberculosis treatment centre in Kampala. Results: Males and females had similar median ages. 80% were currently on co-trimoxazole and 50% of participants were on HAART. Majority of participants defined co-trimoxazole as an analgesic. Few noted co-trimoxazole was a drug to treat cough and chest pain. However, few responses revealed that co-trimoxazole prevents opportunistic diseases among PLHIV. Most of participants believed HAART and anti-TB drugs work as co-trimoxazole thus it should not be taken together with them. This belief may lead to increased risk of opportunistic infections, morbidity and mortality. Conclusions: We revealed gaps in understanding of co-trimoxazole use among study participants. We therefore recommend that more facts about co-trimoxazle as prophylaxis against P. jirovecii, bacterial and diarrheal pathogens should be incorporated in VCT fact sheets.
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    Sero-prevalence of Herpes Simplex Type 2 Virus (HSV-2) and HIV Infection in Kampala, Uganda
    (African health sciences, 2014) Nakku-Joloba, Edith; Kambugu, Fred; Wasubire, Julius; Kimeze, Joshua; Salata, Robert; Albert, Jeffrey M.; Rimm, Alfred; Whalen, Christopher
    Prevalence of herpes simplex type 2 virus (HSV-2) is high worldwide. Previous studies in Uganda were rural or in women. We estimated age and sex-specific sero- prevalence of HSV-2 in Kampala, Uganda.Using two-stage random sampling stratified on population density, a survey of persons 15-65 years was conducted. Type-specific serological tests for HSV-2, HSV-1(HerpeSelect2 and 1 ELISA), HIV (Rapid tests and ELISA), syphilis (RPR and TPHA) were done. Additional prevalence analysis included post-stratification weighting on the Uganda 2002 Census gender distribution.Among 1124 persons, HSV-2 prevalence was 58% (95% CI: 55, 60), HSV-1; 98% (95% CI: 97.6, 99.1), HIV; 17.7% (95% CI: 14.8, 19.2) and syphilis; 1.7% (95% CI: 1.4, 1.9). Weighted HSV-2 prevalence was 53.8% (Women; 63.8%, men; 43.2%), similar to unweighted data. Weighted HIV prevalence was 20.7% in women, 8.6% in men. Of 165 HIV infected persons, 85.4% had HSV-2. Risk factors for HSV-2 were being a woman (OR 2.0; 95% CI: 1.42, 2.78), age (OR 3.3; 95% CI: 2.43, 4.53), education (OR 1.70; 95% CI: 1.34, 2.34) and HIV (OR 4.5; 95% CI: 2.70, 7.50).Prevalence of HSV-2 and HIV was high especially in women. Syphilis was rare. Awareness of herpes was low. Interventions in young people are needed.
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    Therapeutic Challenges of AIDS-Related Non-Hodgkin’s Lymphoma in the United States and East Africa
    (2002-05) Otieno, Mwanda W.; Banura, Cecily; Katongole-Mbidde, Edward; Johnson, John L.; Dowlati, Afshin; Renne, Rolf; Arts, Eric; Whalen, Christopher; Lederman, Michael M.; Remick, Scot C.
    Abstract Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. As we enter the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, it is apparent that the evolution of antiretroviral therapy and the emergence of combination antiviral strategies have greatly affected the natural history of HIV infection and its neoplastic complications. For example, there may be a trend for declining incidence of AIDS-related lymphoma in the United States for the first time. However, in regions of the world where the burden of HIV infection is greatest, such as in East Africa, AIDS-related lymphoma is an increasing cause of morbidity and mortality. Treatment of lymphoma has evolved coincident with improvements in antiretroviral therapy. Infusional chemotherapy regimens may offer advantages over other regimens and schedules, but comparative trials have not been done. Clinical trial data are available on which to develop therapeutic strategies to treat this disease in East Africa where pragmatic approaches are needed. Both the differences in manifestations of HIV infection and the inherent difficulties in administering cytotoxic chemotherapy in this part of the world must be taken into consideration in planning therapeutic strategies. Improved understanding of the pathogenesis of HIV infection and lymphoma will likely yield improved therapeutic interventions as well.
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    Using publicly available, interactive epidemiological dashboards: an innovative approach to sharing data from the Rakai Community Cohort Study
    (Oxford University Press, 2024-10) Footer, Kevin; Lake, Camille M; Porter, Joshua R; Ha, Grace K; Ahmed, Tanvir; Glogowski, Alex; Ndyanabo, Anthony; Grabowski, M Kate; Chang, Larry W; Ssekasanvu, Joseph; Kagaayi, Joseph; Serwadda, David M; Mckina, Jackie; Whalen, Christopher; Ssentongo, Lloyd; Nsimbi, Ivan; Kakeeto, Benedicto; Kigozi, Godfrey; Ssekubugu, Robert; Lutalo, Tom; Wawer, Maria J; Gray, Ronald H; Reynolds, Steven J; Rosenthal, Alex; Quinn, Thomas C; Tartakovsky, Michael
    Public sharing of de-identified biomedical data promotes collaboration between researchers and accelerates the development of disease prevention and treatment strategies. However, open-access data sharing presents challenges to researchers who need to protect the privacy of study participants, ensure that data are used appropriately, and acknowledge the inputs of all involved researchers. This article presents an approach to data sharing which addresses the above challenges by using a publicly available dashboard with de-identified, aggregated participant data from a large HIV surveillance cohort.ObjectivesPublic sharing of de-identified biomedical data promotes collaboration between researchers and accelerates the development of disease prevention and treatment strategies. However, open-access data sharing presents challenges to researchers who need to protect the privacy of study participants, ensure that data are used appropriately, and acknowledge the inputs of all involved researchers. This article presents an approach to data sharing which addresses the above challenges by using a publicly available dashboard with de-identified, aggregated participant data from a large HIV surveillance cohort.Data in this study originated from the Rakai Community Cohort Study (RCCS), which was integrated into a centralized data mart as part of a larger data management strategy for the Rakai Health Sciences Program in Uganda. These data were used to build a publicly available, protected health information (PHI)-secured visualization dashboard for general research use.Materials and MethodsData in this study originated from the Rakai Community Cohort Study (RCCS), which was integrated into a centralized data mart as part of a larger data management strategy for the Rakai Health Sciences Program in Uganda. These data were used to build a publicly available, protected health information (PHI)-secured visualization dashboard for general research use.Using two unique case studies, we demonstrate the capability of the dashboard to generate the following hypotheses: firstly, that HIV prevention strategies ART and circumcision have differing levels of impact depending on the marital status of investigated communities; secondly, that ART is very successful in comparison to circumcision as an interventional strategy in certain communities.ResultsUsing two unique case studies, we demonstrate the capability of the dashboard to generate the following hypotheses: firstly, that HIV prevention strategies ART and circumcision have differing levels of impact depending on the marital status of investigated communities; secondly, that ART is very successful in comparison to circumcision as an interventional strategy in certain communities.The democratization of large-scale anonymized epidemiological data using public-facing dashboards has multiple benefits, including facilitated exploration of research data and increased reproducibility of research findings.DiscussionThe democratization of large-scale anonymized epidemiological data using public-facing dashboards has multiple benefits, including facilitated exploration of research data and increased reproducibility of research findings.By allowing the public to explore data in depth and form new hypotheses, public-facing dashboard platforms have significant potential to generate new relationships and collaborations and further scientific discovery and reproducibility.ConclusionBy allowing the public to explore data in depth and form new hypotheses, public-facing dashboard platforms have significant potential to generate new relationships and collaborations and further scientific discovery and reproducibility. MEDLINE - Academic